Sacral anterior root stimulation improves bowel function in subjects with spinal cord injury

Abstract BACKGROUND: Urinary disorders account for 10% of deaths in patients with complete spinal cord injury. Sacral anterior root stimulation (SARS) may be a valuable therapeutic option to restore complete and voluntary micturition (CVM), but questions on its cost-effectiveness remain. OBJECTIVE: To evaluate the cost-effectiveness of SARS to restore CVM in patients with complete spinal cord injury. METHODS: We conducted a nonrandomized, multicenter, parallel-group cohort study comparing SARS vs current medical treatments with catheterization or reflex micturition. CVM was assessed at 12 months (end of follow-up) by urodynamic examination. Medical and nonmedical costs were measured in the perspective of the French national health insurance. Linear regression models were used to estimate the incremental net benefit (; λ = willingness-to-pay) adjusted for potential confounders, and P (INB >0) (ie, probability of SARS being cost-effective vs medical treatment) for different values of λ. RESULTS: Twenty-five patients were included in each group in 2005 to 2009. At inclusion, mean age was 41 years; 45 (90%) patients were male, and 29 (59%) patients were paraplegic. At 12 months, 15 (60%) patients with SARS had a CVM vs 3 (12%) patients with medical treatment (P < .001). The total mean cost was 42 803€ and 8762€, respectively (P < .001). After adjustment for CVM and voiding methods at inclusion, P (INB >0) was 74% at λ = 100 000€. This probability was 94% in a sensitivity analysis excluding 6 patients presenting a CVM at inclusion. CONCLUSION: The effectiveness and cost of SARS are much higher than for medical treatment. Our results inform decision makers of the opportunity to reimburse SARS in this vulnerable population.

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Urodynamic results, clinical efficacy, and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury

Neurourology and Urodynamics ◽

10.1002/nau.22486 ◽

2013 ◽

Vol 33 (8) ◽

pp. 1202-1206 ◽

Cited By ~ 26

Author(s):

D. Krasmik ◽

Jörg Krebs ◽

Arndt van Ophoven ◽

Jürgen Pannek

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Lower Urinary Tract ◽

Lower Urinary Tract Dysfunction ◽

Complication Rates ◽

Cord Injury ◽

Complete Spinal Cord Injury ◽

Anterior Root ◽

Root Stimulation ◽

Lower Urinary

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A cost-utility analysis of sacral anterior root stimulation (SARS) compared with medical treatment in patients with complete spinal cord injury with a neurogenic bladder

The Spine Journal ◽

10.1016/j.spinee.2015.08.023 ◽

2015 ◽

Vol 15 (12) ◽

pp. 2472-2483 ◽

Cited By ~ 5

Author(s):

Camille Morlière ◽

Elise Verpillot ◽

Laurence Donon ◽

Louis-Rachid Salmi ◽

Pierre-Alain Joseph ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Medical Treatment ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Cord Injury ◽

Complete Spinal Cord Injury ◽

Anterior Root ◽

Root Stimulation

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Sacral Anterior Root Stimulation (SARS) and visceral function outcomes in spinal cord injury – a systematic review of literature over four decades

World Neurosurgery ◽

10.1016/j.wneu.2021.09.041 ◽

2021 ◽

Author(s):

Thomas Guiho ◽

Christine Azevedo-Coste ◽

Luc Bauchet ◽

Claire Delleci ◽

Jean-Rodolphe Vignes ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Review Of Literature ◽

Cord Injury ◽

Anterior Root ◽

Root Stimulation

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Effect of spinal anterior root stimulation and sacral deafferentation on bladder and sexual dysfunction in spinal cord injury

Acta Neurochirurgica ◽

10.1007/s00701-018-3557-1 ◽

2018 ◽

Vol 160 (7) ◽

pp. 1377-1384 ◽

Cited By ~ 3

Author(s):

Hamed Zaer ◽

Mikkel Mylius Rasmussen ◽

Franko Zepke ◽

Charlotte Bodin ◽

Burkhard Domurath ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Sexual Dysfunction ◽

Cord Injury ◽

Anterior Root ◽

Root Stimulation

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The Effect of Exoskeletal-Assisted Walking on Spinal Cord Injury Bowel Function: Results from a Randomized Trial and Comparison to Other Physical Interventions

Journal of Clinical Medicine ◽

10.3390/jcm10050964 ◽

2021 ◽

Vol 10 (5) ◽

pp. 964

Author(s):

Peter H. Gorman ◽

Gail F. Forrest ◽

Pierre K. Asselin ◽

William Scott ◽

Stephen Kornfeld ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Bowel Function ◽

Bowel Dysfunction ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Cord Injury ◽

Patient Reported ◽

Stool Form ◽

Time Since Injury

Bowel function after spinal cord injury (SCI) is compromised because of a lack of voluntary control and reduction in bowel motility, often leading to incontinence and constipation not easily managed. Physical activity and upright posture may play a role in dealing with these issues. We performed a three-center, randomized, controlled, crossover clinical trial of exoskeletal-assisted walking (EAW) compared to usual activity (UA) in people with chronic SCI. As a secondary outcome measure, the effect of this intervention on bowel function was assessed using a 10-question bowel function survey, the Bristol Stool Form Scale (BSS) and the Spinal Cord Injury Quality of Life (SCI-QOL) Bowel Management Difficulties instrument. Fifty participants completed the study, with bowel data available for 49. The amount of time needed for the bowel program on average was reduced in 24% of the participants after EAW. A trend toward normalization of stool form was noted. There were no significant effects on patient-reported outcomes for bowel function for the SCI-QOL components, although the time since injury may have played a role. Subset analysis suggested that EAW produces a greater positive effect in men than women and may be more effective in motor-complete individuals with respect to stool consistency. EAW, along with other physical interventions previously investigated, may be able to play a previously underappreciated role in assisting with SCI-related bowel dysfunction.

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